Body Composition and Outcomes in Dialysis Patients and Renal Ttransplant Recipients

authors:

avatar Miklos Z Molnar 1 , avatar Kamyar Kalantar-Zadeh 2 , *

1) Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA. 2) Institute of Pathophysiology, Semmelweis University, Hungary
1) Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA. 2) David Geffen School of Medicine, UCLA, kamkal@ucla.edu, CA, USA
Nephro-Urology Monthly: Vol.3, issue 3; 155-63
article type: Review Article
received: April 13, 2011
accepted: April 30, 2011

how to cite: Molnar M, Kalantar-Zadeh K. Body Composition and Outcomes in Dialysis Patients and Renal Ttransplant Recipients. Nephro-Urol Mon. 2011;3(3): 155-63. 

Abstract

Overweight (body mass index [BMI] = 25 - 30 kg/m2) and obesity (BMI ≥ 30 kg/m2) have become mass phenomena with a pronounced upward trend in prevalence in most countries throughout the world and are associated with increased cardiovascular risk and poor survival. In patients with end stage renal disease (ESRD) undergoing maintenance hemodialysis an 'obesity paradox' has been consistently reported, i.e., a high BMI is incrementally associated with better survival. Whereas this 'reverse epidemiology' of obesity is relatively consistent in maintenance hemodialysis patients, studies in peritoneal dialysis patients have yielded mixed results. Moreover, the effect of pre- and post-transplant obesity in kidney transplanted patients on long-term graft and patient survival has not been well established. However, BMI is unable to differentiate between adiposity and muscle mass and may not be an acceptable metric to assess the body composition of ESRD patients. Assessing lean body mass, in particular skeletal muscle, and fat mass separately are needed in ESRD patients using gold standard techniques such as imaging techniques. Alternatively, inexpensive and routinely measured surrogate markers such as serum creatinine, waist and hip circumference or mid-arm muscle circumference can be used. We have reviewed and summarized salient recent data pertaining to body composition and clinical outcomes about the association of survival and body composition in maintenance dialysis patients and kidney transplanted recipients.

 

 

Implication for health policy/practice/research/medical education:
BMI is not adequate to assess the obesity or body composition in ESRD, and higher BMI is not necessarily associated with poor outcomes in dialysis or kidney transplanted patients.
Please cite this paper as:
Molnar MZ, Kalantar-Zadeh K. Body Composition and Outcomes in Dialysis Patients and Renal Transplant Recipients. Nephro-Urol Mon. 2011;3(3):155-163.
Article history:
Received: 13 Apr 2011
Revised: 23 Apr 2011
Accepted: 30 Apr 2011

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